Insurance Membership Request Form

Please complete all the details below for your insurance membership request and allow up to seven business days for your request to be processed.


Please enter your contact information

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Member Details

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Select your membership option

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Invoicing Details

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Membership start date(*)

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Supporting Documentation

If you have any supporting documentation, please upload.
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Additional comments

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We'd love to hear from you

Complete the form below with details of your enquiry and we'll get back to you within seven days.

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Please include a valid email address.
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Craigie Leisure Centre

Whitfords Avenue
Craigie WA 6025
9400 4600

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